No abstract available.

We report two cases of hyalinizing trabecular carcinoma (HTC) of the thyroid gland. These two patients were euthyroid women aged 36 and 65 years of age. The tumors were encapsulated and measured 0.8 and 4.0 cm in diameter, respectively. Histologically, the tumors were composed of a compact proliferation of cells in a lobular and trabecular pattern with an intervening hyalinized, fibrotic vascular stroma. Occasionally the cells were arrayed in microfollicles. Multiple and serial sections showed cords of tumor cells invading into the capsule in both cases and vascular invasion in one case. These findings suggested that HTCs are a malignant counterpart of hyalinizing trabecular adenoma, similar to conventional follicular tumor. Positive immunostaining of tumor cells for thyroglobulin and negative staining for high molecular weight cytokeratin, cytokeratin 19, neuron specific enolase, chromogranin, and synaptophysin allowed distinction from medullary carcinoma. Even though HTCs are an heterogeneous group of tumors, the present two cases are probably variants of follicular carcinoma rather than papillary carcinoma.
Adenoma ; Carcinoma, Medullary ; Carcinoma, Papillary ; Female ; Humans ; Hyalin* ; Keratin-19 ; Keratins ; Molecular Weight ; Negative Staining ; Phosphopyruvate Hydratase ; Synaptophysin ; Thyroglobulin ; Thyroid Gland*

The incidence of severe hepatitis A virus (HAV) infection has been increasing. However, clinicopathologic features of severe HAV infection that lead to liver transplantation (LT) have not been reported in Korea. We retrieved 16 LT cases with HAV infection during the last 3 years at Asan Medical Center, Seoul, Korea. Fifteen cases progressed to hepatic encephalopathy. Thirteen cases survived with or without complications, and three patients died of sepsis. The explanted liver showed massive or zonal necrosis with moderate to severe cholestasis. The zonal distribution of necrosis was frequently associated with endothelialitis of portal and/or central veins. Degenerative changes of hepatocytes were various in degree and distribution. Viral inclusions were suspected in two cases. Although HAV infection is usually confirmed by serological tests, significant venulitis of central and/or portal veins and viral inclusions, which are rarely observed, can suggest an HAV infection as a cause of massive hepatic necrosis of unknown mechanism.
Cholestasis ; Fluconazole ; Hepatic Encephalopathy ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Hepatocytes ; Humans ; Incidence ; Korea ; Liver ; Liver Transplantation ; Massive Hepatic Necrosis ; Necrosis ; Portal Vein ; Sepsis ; Serologic Tests ; Veins

Dural shunts are vascular communications in which blood flows through small meningeal branches of the carotid arteries to enter the venous circulation near the cavernous sinus. The clinical characteristics of 13 eyes[12 patients] with dural cavernous sinus fistula are described. Of these patients, 84.6%[11 eyes]were women with dilated conjunctival and episcler-al vessels, exophthalmos, retinal hemorrhage and venous engorgement, elevation of intraocular pressure, swelling of lid and orbital area, limited eye movement and diplopia, and bruit, in order of frequency. Decreased vision had occurred in only 1 eye, due to central retinal vein obstruction during follow-up periods after embolization. CT or MRI scan showed the enlargement of the extraocular muscle and superior ophthalmic vein. Two eyes had resolved spontaneously. Ten eyes of dural cavernous sinus fistula had the resolution of clinical symptoms after carotid angiography with embolization. The complications after embolization had occurred in one eye with transient sensory deficit of face.
Angiography ; Carotid Arteries ; Cavernous Sinus* ; Diplopia ; Exophthalmos ; Eye Movements ; Female ; Fistula* ; Follow-Up Studies ; Humans ; Hyperemia ; Intraocular Pressure ; Magnetic Resonance Imaging ; Orbit ; Retinal Hemorrhage ; Retinal Vein ; Veins

No abstract available.
Animals ; Rats* ; Sciatic Nerve*

Nurses experience role conflict between nursing theory that they learned in school and clinical nursing practice. This conflict lead to lower self-image, self-esteem, job dissatisfaction. Also, the professionalism of nurses is estimatable by the grade of autonomy. The professional autonomy requires individual and professional obligation about her decision and performance. A lack of professional autonomy results in the job dissatisfaction. Job dissatisfaction leads to absenteeism, increased proneness to mental and physical illness and higher turnover rates. The purpose of this study was o investigate professional autonomy and self-concept of clinical nurses. Data were collected from 262 clinical nurses in P city from June 1 to June 30, 1996. The instruments used for this study were made by Arthur(1990) and Schutzenhofer(1983). The data were analyzed for frequency and percentage, mean, SD, t-test, ANOVA, Pearson's correlation coefficient, stepwise multiple regression, using SAS PC+ Program. The findings were as it follows : 1. The mean of professional autonomy and self-concept were 152+/-18.48, 70.65+/-8.20(2.62), respectively. These showed mid level of professional autonomy and self-concept. 2. Professional autonomy of clinical nurses was found to vary significantly according to total years of clinical experience(F=4.49, p<0.01), position(F=3.49, p<0.05), and state under study for the degree(F=3.83, p<0.05). Professional self-concept was found to vary significantly according to age(F=3.52, p<0.05), marital status(F=7.39, p<0.001), total years of clinical experience(F=3.59, p<0.05), position(F=5.22, p<0.01), the expectant period being on the duty as clinical nurse(F=8.34, p<0.001), and motivation of choosing nursing(F=5.17, p<0.001). 3. The statistical relationship between clinical nurses' profession autonomy and self-concept was found as positive correlation9r=0.42246, p<0.001). 4. Professional autonomy was the highest factor predicting professional self-concept(17.85%). Professional autonomy and marital status accounted for 20.60% in professional self-concept of clinical nurses. In conclusion, Professional autonomy and self-concept of clinical nurses showed significantly positive relationship. Therefore, nursing education needs to develop programs and policies to increase professional autonomy and self-concept of clinical nurses.
Absenteeism ; Education, Nursing ; Humans ; Marital Status ; Motivation ; Nursing ; Nursing Theory ; Professional Autonomy*

Actinomycosis is a chronic suppurative and granulomatous disease characterized by peripheral spread and extension to contagious tissue, rare hematogenous spread, and the formation of multiple draining sinus tracts. In the rare case of hematogenous disseminated Actinomycosis; lesions appear in all parts of the body. Bone involvement, however, is very rare except the jaw and there has been only some reports about the ribs and vertebral columns. To our knowledge, this case represents the first report of documented distal femoral involvement.
Actinomycosis ; Femur ; Fractures, Spontaneous ; Jaw ; Osteomyelitis ; Ribs ; Spine

Dislocation of the clavicle at its sternal end is relatively rare, as compared with acromioclavicular dislocation. Among them, the posterior dislocation of the sternoclavicular joint was extremely rare. So, not more than fifty cases had been reported in the literature. Of these three main typesanterior, superior, and posterior-the anterior one is by far the most common. Most authors have stressed the difficulty in confirming the diagnosis with routine radiographs. We experienced a case of traumatic posterior dislocation of the sternoclavicular joint treated successfully by manipulative reduction. So, we report it with review of literature.
Clavicle ; Diagnosis ; Dislocations ; Sternoclavicular Joint

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004–2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004–2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS’s cumulative reserves will run out by 2024. Conclusion In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

Unmet healthcare is an important indicator to measure accessibility of healthcare services. To examine the latest status of unmet healthcare needs in South Korea, four different data which is composed of nationally representative sample of South Korean population were used; the Korea National Health and Nutrition Examination Survey (KNHANES, 2007–2020), the Community Health Survey (CHS, 2008–2020), the Korea Health Panel Survey (KHP, 2011–2018), and the Korean Welfare Panel Study (KOWEPS, 2006– 2020). The proportion of individuals reporting unmet healthcare needs were 6.4% (KNHANES), 5.4% (CHS), and 12.2% (KHP). Annual percentage change (APC) which identifies trend for the follow-up period was -9.9%, -9.1%, and -5.5%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost were 1.0% (KNHANES), 0.4% (CHS), 2.2% (KHP), and 0.4% (KOWEPS). The APC was -11.3%, -17.0%, -12.2%, and -21.2%, respectively. Overall, the low-income and the elderly population reported a higher rate of unmet health care needs. Although the overall experience rate of unmet medical care due to cost decreased over the past decade, the disparity between the lowest and highest income groups still remained in 2020. Disparity between income levels and age groups is a challenge to address in healthcare system, and these results suggest the need for adequate health coverage for the low-income and the elderly populations.